Epistemic Injustice in Women's Reproductive Healthcare

1. Epistemic Injustice A Philosophical Analysis of Women’s
Reproductive Health Care in a Somali-American Community
by Robin Narruhn & Terri Clark
Robin Narruhn PhD MN RN

2. Genesis of Article
 Witness to the philosophical differences between a biomedical system and
a specific community
 Miscommunication
 Critical Event
 Birth inequities

3. Ways of Knowing
~Patterns of Knowing~
 includes empiric, personal,
aesthetic, ethical, and emancipatory
knowledge,
 defines the different types of
knowledge and how they relate to
each other.

4. Ways of Knowing
• Personal Knowing- refers to the knowledge we have of ourselves and what we have
seen and experienced. This type of knowledge comes to us through the process of
observation, reflection, and self-actualization
• Aesthetic Knowing -Aesthetic knowing makes nursing an “art.”
• Empirical Knowing -knowledge from research and objective facts.
• Ethical Knowing -knowing helps one develop our own moral code; our sense of
knowing what is right and wrong.
• Emancipatory Knowing -critical framework to learn how to advocate for social
justice and to question structural barriers that result in healthcare inequity.

5. Miranda
Fricker
Epistemic Injustice-
a form of injustice that
harms a person in his
or her capacity as a
knower.

6. Epistemic Injustice
Testimonial injustice- occurs when a prejudice causes a hearer to
give a deflated level of credibility to a speaker's world.
Hermeneutical injustice- (hermeneutic = method of
interpretation) occurs when a gap in collective interpretive resources
puts someone at an unfair disadvantage when it comes to making
sense of their social experiences.
(Fricker, 2007)

7. Epistemic Injustice & Birthing
• Informed Consent- full consent (short/long term, diagnostic/curative)
• Constructed – “Maternal Fetal Rights” Paradigm (Cartesian split vs union)
• Risk Discourse i.e. disease state/medicalization vs physiological process
• Power Differentials esp. in relation to Intersectionality i.e. multiple categories of identity
• Discordant & Obscured but Privileged Values i.e. Physiologic vs a Technological Interventionist Birth
• Differing Conceptualizations of Autonomy i.e. individual vs relational/communitarian
• Legitimacy of Specific Knowledge Systems aka Authoritative Knowledge

8. Authoritative Knowledge
“When equally and legitimate parallel knowledge
systems exist . . . people move easily between them
using them sequentially or in parallel fashion for
particular purposes. But frequently one knowledge
system gains ascendance and legitimacy. A
consequence of legitimization of one kind of
knowing as authoritative is the devaluation often
the dismissal of other ways of knowing. Those who
espouse alternative knowledge systems then tend to
be seen as backward, ignorant, and naïve, or worse,
simply as trouble makers." Jordan, 1997 (p56)

9. Case Studies
• In this article we illustrate how these concepts are manifested in the clinical
setting by providing several case studies.

10. Recommendations
(1) a more critical use of technology with attention paid to the unintended consequences,
(2) a culturally safe and patient-centered approach to care,
(3) a physiologic approach to birth that is more consistent with the values of the Somali community, or
of any person's relevant community,
(4) full, nonbiased disclosure of the various options regarding technology,
(5) a fully-informed consent process regarding routine use of prenatal screening, diagnosis, and
perinatal assessment technology,
(6) translation of research on social determinants of health into action in the clinical context,
(7) an approach to pedagogy and disparity reduction that uses a structural competency lens, and
(8) legitimizing the use of epistemic diversity